Reducing Hypertension among African American Men: A Mobile Stress Management Intervention to Address Health Disparities

减少非裔美国男性的高血压：解决健康差异的移动压力管理干预措施

• 批准号: 10384110
• 负责人: Samantha L. Leaf
• 金额: $ 25.75万
• 依托单位: ISA ASSOCIATES, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-18 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10384110
• 关键词: Address; Adherence; African American; Alcohol consumption; Antihypertensive Agents; Area; Attention; Behavior; Behavioral; Biological; Blood Pressure; Car Phone; Cardiovascular Diseases; Cellular Phone; Chronic; Cognition; Cognitive; Coping Behavior; Coping Skills; Development; Diabetes Mellitus; Diagnosis; Diastolic blood pressure; Discrimination; Emotions; Enrollment; Etiology; Familiarity; Feedback; Focus Groups; Frequencies; Gender; Goals; HIV; Homicide; Hyperphagia; Hypertension; Individual; Internet; Intervention; Knowledge; Learning; Libraries; Life Expectancy; Life Experience; Link; Measures; Medical; Minority Groups; Participant; Pharmaceutical Preparations; Phase; Physical activity; Physiological; Privacy; Relaxation Techniques; Research; Resources; Security; Series; Shapes; Smoking; Source; Stress; Stress and Coping; Stroke; System; Testing; Text Messaging; Thinking; Touch sensation; Training; United States; Work; allostatic load; base; behavioral health; black men; blood pressure intervention; blood pressure reduction; blood pressure regulation; cardiovascular risk factor; coping; coping mechanism; cost; cost effective; design; experience; health disparity; hypertension control; improved; mHealth; medication compliance; men; mindfulness; mindfulness meditation; mobile computing; modifiable risk; mortality; non-compliance; peer; preference; programs; prototype; psychologic; racial discrimination; racial disparity; recruit; response; skills; stress management; stressor; substance use; text messaging intervention; theories; therapy design; usability; web-based assessment

PROJECT SUMMARY/ABSTRACT African American men have the highest rate of hypertension (HTN) in the United States. Once diagnosed, they are also less likely than other groups to achieve blood pressure (BP) control. This health disparity is critical, as elevated BP is the primary modifiable risk factor for cardiovascular disease. One reason for this HTN disparity: stress. African Americans experience more stress than their White peers, most notably from racial discrimination, and have fewer resources to manage these stressors. This stress has significant physiological consequences. Compared to Whites, African Americans show heightened allostatic load, a measure of the biological effects of chronically activating the stress physiological systems. Importantly, stress-induced activation of these systems is implicated in the etiology of HTN. Stress also exacerbates HTN through unhealthy coping (e.g., smoking, overeating, alcohol use) and poorer adherence to antihypertensive medications. Stress predicts these coping behaviors and medical noncompliance in African Americans. Despite clear links between stress and HTN, stress management is not regularly deployed to manage BP. This is a missed opportunity because stress management interventions have been shown to improve HTN. Existing research on stress management interventions for BP reduction included mostly White participants. This is significant because behavioral health programs designed specifically for minority groups are more effective than generic programs. Because stress significantly drives health disparities in HTN, developing effective stress management programs for African American men is vital to closing this gap. One cost-effective, easily scalable solution is mHealth. One of the most accessible mobile formats is text messaging. Importantly, 98% of African Americans own a mobile phone. Most are smartphones (70%). To our knowledge, no mobile cognitive behavioral stress management intervention has been developed for African American men to manage racial and nonracial sources of stress in an effort to reduce HTN disparities. We intend to fill this void. When completed, educational text messages will increase knowledge, develop skills, and reduce barriers to adaptive coping. Supportive texts will affirm the life experiences of African American men. A library of individually tailored videos will be delivered to each user depending on a theory-based assessment of stress (including perceived discrimination) and coping. All mobile web content will be effortlessly and efficiently accessed via touch-based links embedded within text messages. Eighteen African American men will be recruited for focus group discussions to inform prototype development. When the prototype is completed, these 18 target end-users will return for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and acceptability.

项目总结/摘要 非洲裔美国人是美国高血压（HTN）发病率最高的人群。一旦确诊， 他们也不太可能比其他群体实现血压（BP）控制。这种健康差距是 这一点至关重要，因为血压升高是心血管疾病的主要可改变风险因素。 HTN差异的一个原因是：压力。非裔美国人比他们的白色人经历更多的压力 同龄人，最主要的是种族歧视，管理这些压力源的资源较少。该应力 会产生严重的生理后果与白人相比，非裔美国人表现出更高的抗静电能力， 负荷，长期激活应激生理系统的生物效应的量度。重要的是， 应激诱导的这些系统激活与HTN的病因有关。压力也会加重HTN 通过不健康的应对（例如，吸烟、暴饮暴食、饮酒）和抗高血压药物依从性较差 药物治疗压力预测这些应对行为和非裔美国人的医疗不遵守。尽管 压力与HTN之间存在明显联系，因此压力管理不会定期用于管理BP。这是一 错过了机会，因为压力管理干预已被证明可以改善HTN。 现有的关于降低血压的压力管理干预的研究主要包括白色 参与者这一点很重要，因为专门为少数群体设计的行为健康计划 比一般的程序更有效。因为压力显著地驱动了HTN中的健康差异， 为非裔美国男性制定有效的压力管理计划对于缩小这一差距至关重要。 一个具有成本效益，易于扩展的解决方案是mHealth。最容易使用的移动的格式之一是文本 信息传送.重要的是，98%的非洲裔美国人拥有移动的手机。大多数是智能手机（70%）。 据我们所知，没有移动的认知行为压力管理干预已经开发用于 非裔美国人管理种族和非种族的压力来源，以减少HTN的差异。 我们打算填补这一空白。完成后，教育短信将增加知识，发展技能， 并减少适应性应对的障碍。支持性文本将肯定非裔美国人的生活经历 男人根据基于理论的 压力评估（包括感知到的歧视）和应对。所有移动的网页内容都将 通过嵌入在文本消息中的基于触摸的链接轻松有效地访问。 将招募18名非洲裔美国人进行焦点小组讨论， 发展原型完成后，这18个目标最终用户将返回进行可用性测试。的 可用性测试将包括一系列任务，旨在突出所建议的 干预将评估三个可用性指标：效率、准确性和可接受性。